Hair is the precious crown we never take off. Most of us invest time and money in our tresses
to make them look show-stopping because “life isn’t perfect, but hair can be.” However, the
millions of people suffering from trichotillomania (pronounced trick-oh-till-oh-mane-ee-
ah, also known as trich) have a totally different approach to hair: they repeatedly pull it as a
way to release stress and deal with tension.

What Exactly Is TTM?
Just like kleptomania or pyromania, the hair pulling disorder is a scientifically-recognized
impulsive behavior that leads people to pull out hair in any region of the body (it usually
happens with the scalp, eyelids and eyebrows). This can be done on purpose or
unconsciously, using just the hands or tools, such as combs, brushes or tweezers. Most trich
sufferers focus on the crown area of the head pulling strand by strand or clumps, and ending
up with bald patches.
TTM affects mostly females and approximately 1%-2% of adults and adolescents.

Causes of Trichotillomania
The exact causes of TTM are still unclear, but the condition often occurs along with mental
illness, anxiety and depression. Also, people who have had cases of trich in their family are
more prone to suffering from it. Scientists believe TTM to be triggered by a chemical brain
imbalance (just like Tourette’s syndrome, Alzheimer’s or Parkinson’s), but they are also
looking into changes in hormone levels during puberty.

What Does TTM Lead to?
Initially, people affected by trich suffer from depression, low self-esteem, or anxiety. This
may follow tragic or shocking events like the death of a loved one, or the sudden loss of a
job. Once people have this addiction, the more hair they pull out, the more they keep doing it.
Some will make this their secretive behavior trying to hide the hair pulling from the people
around them.
Plucking hairs compulsively leads over time to baldness (hair follicles are destroyed at the
root preventing regrowth) and carpal tunnel syndrome (pressure on a nerve in the wrist). As a
direct consequence, the loss of hair causes emotional distress, embarrassment and isolation,
with many patients being ashamed to use wigs or concealing makeup (in the case of over-
plucked eyebrows). Victims feel powerless and are overwhelmed with additional stress which
leads to more hair pulling.
Unfortunately, there are also sufferers with the habit of eating their pulled hair. This can
cause hairballs to form in the stomach, leading to severe illnesses such as weight loss,
digestive blockages, and many more.

Signs and Diagnosis

Since there is no specific test for diagnosing trich, the very presence of physical signs and
symptoms can show a patient is suffering from it. The most common ones are:
Bald patches on the scalp, body or face;
Missing eyelashes, eyebrows (sometimes they look very thin losing their natural shape);
Strange behavior, such as inspecting the hair root, twirling the hair or pulling it
between the teeth, chewing or even eating hair, rubbing removed hair across the face or lips;
People who tick any of the above boxes should decide to visit a doctor, or should be
advised to do so as soon as possible. The specialist will examine the areas where the hair
is missing looking for any other possible factors that might be causing the hair to come
out, such as skin infections. The physician will want to know how frequent the habits are
and also the triggering circumstances. The patient will be questioned about the feelings
surrounding this behavior and what he or she feels before, after and during pulling the
hair. Sometimes, a skin or hair sample will be needed for biopsy to further analyze the
causes for hair loss.

Possible Treatments for Trichotillomania

When it comes to curing trich, the most effective methods of treatment are behavioral therapy
and medications, usually combined for better results.
Through habit reversal training, the patient is taught how to replace a bad habit with a new
one that is harmless (squeezing a stress ball, for example). Patients will learn how to identify
the urge to pull hair (having to cover their hands in that moment) and how to relax in order to
ease the tension when they feel like doing it. Hypnosis and biofeedback are further solutions
offered by alternative medicine.
Antidepressants (e.g. Prozac, Zoloft, Luvox, Paxil) may also be part of the treatment, but they
only offer temporary help because symptoms will return once the medication is stopped.
Drugs are normally prescribed to reduce depression and curb intense urges.
While undergoing counselling and mental or emotional therapy, some victims will choose to
cut their hair short, or simply invest in wigs and hairpieces or hats to hide their bald patches.

Getting Support for TTM
Hiding TTM will only make things worse, so patients should open up about it with their
loved ones. Looking for support groups and meeting people who are also affected by this
condition is also beneficial. The most important step is that you talk to your physician or a
mental health specialist to get more information on trich.
Seek help for yourself or your loved ones and be honest about who you are. Last but not least,